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"...Our NPs work in exactly the same way as the Drs because usually they're at least part trained by them.
I don't understand an NP nor knowing whatt investigations to order to help make a diagnosis. But maybe that's becasue they have no idea what they might be dealing with as they don't take a full history or do a focused clinical examination..."
Excuse me, but where did you come up with this?
Everyone needs to be reminded that doctors have a 'license to practice' not a license for perfection of solving a problem. So it's a constant life of practicing, thus the reason for many different tests and the prescribing of various /rx's until they get it right. Nurses just follow doctors directions. Whether you see the doc or not the nurse probably has confered with a doctor somewhere in the facility and was told what to prescribe.
I've been to several different doctors over the years and even before 'google' I saw doctors looking up the problem and the possible solutions in one of their medical books sitting on their desk.
When you see a doctor and tell him your symptoms and then he leaves the examining room, 10 to 1 he's in his office googling the situation and looking for various treatments to reccomend. Then he or the nurse comes back to you with a r/x hoping that cures your problem.
When you select a doctor it's generally because you feel comfortable with him/her and are hoping that they are reliable or knowledgeable enough to cure your problem.
You can got to 3 different doctors for the same problem and it wouldn't be unusual to get 3 different opinions.
A good example is the flu outbreak going on right now. There are several different strains of the flu and many doctors are treating patients for it, even if they just have a cold or sinus problem, and are telling the patients what they want to hear since too many are convinced that they have this swine flu. This was reported on the national news the other night and how people are flooding ER's thinking they have the current flu strain even though they don't. So many ER's and urgent care centers are being tied up with insecure patients who think they know best.
"...Our NPs work in exactly the same way as the Drs because usually they're at least part trained by them.
I don't understand an NP nor knowing whatt investigations to order to help make a diagnosis. But maybe that's becasue they have no idea what they might be dealing with as they don't take a full history or do a focused clinical examination..."
Excuse me, but where did you come up with this?
From having seen RNs/ NPs/MDs and PAs here in the US in action.
This includes in ER, minute clinic, PCP and specialist office visits.
Everyone needs to be reminded that doctors have a 'license to practice' not a license for perfection of solving a problem. So it's a constant life of practicing, thus the reason for many different tests and the prescribing of various /rx's until they get it right. Nurses just follow doctors directions. Whether you see the doc or not the nurse probably has confered with a doctor somewhere in the facility and was told what to prescribe.
I've been to several different doctors over the years and even before 'google' I saw doctors looking up the problem and the possible solutions in one of their medical books sitting on their desk.
When you see a doctor and tell him your symptoms and then he leaves the examining room, 10 to 1 he's in his office googling the situation and looking for various treatments to reccomend. Then he or the nurse comes back to you with a r/x hoping that cures your problem.
When you select a doctor it's generally because you feel comfortable with him/her and are hoping that they are reliable or knowledgeable enough to cure your problem.
You can got to 3 different doctors for the same problem and it wouldn't be unusual to get 3 different opinions.
A good example is the flu outbreak going on right now. There are several different strains of the flu and many doctors are treating patients for it, even if they just have a cold or sinus problem, and are telling the patients what they want to hear since too many are convinced that they have this swine flu. This was reported on the national news the other night and how people are flooding ER's thinking they have the current flu strain even though they don't. So many ER's and urgent care centers are being tied up with insecure patients who think they know best.
In the past couple of years, I have gone to the emergency department twice, and on both occasions, I was subjected to a very expensive text procedure before I was seen by a doctor or even a physician's assistant. One was a CAT scan, and the other an Ultrasound. I questioned both. The CAT scan was unnecessary, because my head cut (30 stitches) was a glancing wound by a sharp object, not an impact, and I felt no head pain. The ultrasound was done, even though I explained that the symptoms were most likely a recurrence of a prior chronic condition and I would probably only need and antibiotic. The nurse said afterwards that it was a good thing they did the ultrasound, the doctor was going to want to see that, and then it turned out to be negative, and that I had correctly self-diagnosed. The PA referred me to a specialist outside the OR, after giving me what the specialist called "the wrong antibiotic, but it will probably work". In neither case was I seen by a doctor in ER (both times by a PA).
I found it rather disconcerting that I was assigned by triage to inutile diagnostic procedures billled at thousands of dollars, after I had explained the circumstances of the incidents and the improbability that the tests would be of any value or interest to a real doctor. It is simply the flow-chart mentality, flying beneath the radar of knowledgeable judgment, which pretty much has a stranglehold on everyday American life.
A head wound that required 30 stitches seems significant enough to warrant an imaging study to me. There would be no other way to be sure the wound had not caused some bleeding inside the skull, even if you were sure it had not. A normal test is not necessarily one that is unnecessary. What were you doing? Sword fighting?
If you had a flare up of an old condition, why did you go to the ER and not your family doctor? How could you be sure that the symptoms were not due to a change in the prior condition? Again, a normal test may still be an indicated test.
I do agree about cookbook medicine. The upside is that it tends to reduce errors of omission: the test that should have been done that was not ordered. it's like a pilot's pre-flight checklist. It also helps physician extenders gather information.
But a lot of times a good clinician will arrive at the same diagnosis with fewer tests.
You also have to add in the legal aspect. ERs do not like to send someone out of the ER who has a life-threatening condition. That would include bleeding in the brain in a patient who did not think he was hit very hard.
Any time you go to an ER you will leave with a big bill and probably get tests your own doctor might have skipped. The key is deciding whether a condition actually is an emergency or whether it could wait until the doctor's office is open. You also have the right to decline any test if you do not want to have it done. If you do that, you also have to accept the responsibility if the test would have shown something significant.
A head wound that required 30 stitches seems significant enough to warrant an imaging study to me. There would be no other way to be sure the wound had not caused some bleeding inside the skull, even if you were sure it had not. A normal test is not necessarily one that is unnecessary. What were you doing? Sword fighting?
If you had a flare up of an old condition, why did you go to the ER and not your family doctor? How could you be sure that the symptoms were not due to a change in the prior condition? Again, a normal test may still be an indicated test.
.
I stumbled and fell, my head glancing off a sharp cornered object on the way down, tearing the skin. I know what it feels like when I bump my head, and I didn't bump it. I've bumped my head and seen stars dozens of times before that, harder than that, with no imagery, I shake it off and go on. I went to the ER to stop the bleeding. Our economy can not afford a several-thousand dollar series of diagnostic tests every time a patient presents for stitches "just in case".
My "old condition" was treated with antibiotics, it was a weekend, and it would have been two days before I could even call my doctors office for an appointment, plus however many more days to get in to see him. I could get a one-week head start on the antibiotic treatments by going to the ER doctor. I was right, it was diagnosed as what I thought it was, and I was right, I was taking an antibiotic an hour later instead of 4 or 5 days or more. This was the 3rd or 4th time I had this, and my prior doctors told me to expect it to recur.
I stumbled and fell, my head glancing off a sharp cornered object on the way down, tearing the skin. I know what it feels like when I bump my head, and I didn't bump it. I've bumped my head and seen stars dozens of times before that, harder than that, with no imagery, I shake it off and go on. I went to the ER to stop the bleeding. Our economy can not afford a several-thousand dollar series of diagnostic tests every time a patient presents for stitches "just in case".
My "old condition" was treated with antibiotics, it was a weekend, and it would have been two days before I could even call my doctors office for an appointment, plus however many more days to get in to see him. I could get a one-week head start on the antibiotic treatments by going to the ER doctor. I was right, it was diagnosed as what I thought it was, and I was right, I was taking an antibiotic an hour later instead of 4 or 5 days or more. This was the 3rd or 4th time I had this, and my prior doctors told me to expect it to recur.
Thanks for the clarification.
I was joking about sword fighting, but my DH did end up in the ER for stitches from sharpening a sword. He collects sharp, pointy things of all sizes.
You can largely thank our legal system for the CYA testing that goes on in ERs. They are not sued for doing too many tests, but they almost certainly will get sued for not doing a test that might have picked up something serious had it been done.
Remember that you do have the right to say that you do not want to have a test done. You have a right to say that you do not want to make that decision until after you have been seen by the doctor, examined, and discussed the indication for the test with that doctor.
I stumbled and fell, my head glancing off a sharp cornered object on the way down, tearing the skin. I know what it feels like when I bump my head, and I didn't bump it. I've bumped my head and seen stars dozens of times before that, harder than that, with no imagery, I shake it off and go on. I went to the ER to stop the bleeding. Our economy can not afford a several-thousand dollar series of diagnostic tests every time a patient presents for stitches "just in case".
My "old condition" was treated with antibiotics, it was a weekend, and it would have been two days before I could even call my doctors office for an appointment, plus however many more days to get in to see him. I could get a one-week head start on the antibiotic treatments by going to the ER doctor. I was right, it was diagnosed as what I thought it was, and I was right, I was taking an antibiotic an hour later instead of 4 or 5 days or more. This was the 3rd or 4th time I had this, and my prior doctors told me to expect it to recur.
Fortunately you didn't suffer from a fractured skull or subdural or subarachnoid bleed from your fall. Fortunately your "old condition" didn't show any new development, such as an abscess or a perforation. I'm sure you would not have considered legal action had the tests not been performed and things turned out differently. Fortunately the providers who cared for you practiced according to the standard of care.
From having seen RNs/ NPs/MDs and PAs here in the US in action.
This includes in ER, minute clinic, PCP and specialist office visits.
Then either you don't know what a focused exam is or what part of a history is necessary to treat someone in an urgent care or minute clinic. If your primary care provider isn't doing this at your office visit, I would suggest you change who you go to for your health care.
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